Factors associated with negative conversion of viral RNA in patients hospitalized with COVID-19

Abstract

Journal Pre-proof J o u r n a l P r e -p r o o f Journal Pre-proof J o u r n a l P r e -p r o o f 3 Abstract Factors associated with negative conversion of SARS-CoV-2 RNA in hospitalized patients have not yet been systematically determined. We conducted a retrospective cohort study of COVID-19 patients in Qingdao, China. Both univariate and multivariate analysis were performed to identify independent factors for time to viral RNA negative conversion. Data on patients with re-detectable viral RNA after showing negative on RT-PCR test (intermittent negative status) were also analyzed. A total of 59 patients confirmed with COVID-19 were included in this study, with a median duration of 1 (interquartile range, IQR: 0-2) day from symptom onset to hospital admission. Median communicable period (from first day of positive nucleic acid test to first day of consecutive negative results) was 14 (IQR: 10-18) days, and 7 (IQR: 6-10) days for 10 patients with intermittent negative results. Age older than 45 years (hazard ratio, HR: 0.378; 95% confidence interval, CI: 0.205-0.698) and chest tightness (HR: 0.290; 95%CI: 0.091-0.919) were factors indepently affecting negative conversion of SARS-CoV-2 RNA. Headache (odds ratio: 7.553; 95%CI: 1.011-28.253)was significantly associated with intermittent negative status, with a predicted probability of 60%. Older age and chest tightness were independently associated with delayed clearance of SARS-CoV-2 RNA in hospitalized patients. These predictors would provide a new perspective on early identification of patients with prolonged viral shedding and facilitate optimal isolation protocols and treatment strategies.

Predictors of characteristics associated with negative first SARS-CoV-2 PCR testing despite final diagnosis of COVID-19, and association with treatment and outcomes. The COVID-19 RT-PCR Study

“…Interestingly, Hu et al. found than headache was associated with intermittent negative SARS-CoV-2 RT-PCR status (16), highlighting our results about headache in the multivariate analysis.…”

“…The proportion of "case" and "control" patients who received at least one treatment (chloroquine, corticosteroids, lopinavir/ritonavir, macrolids or tocilizumab) did not differ (P=0.26) ( Table 3). Mechanical ventilation was required for 10 (12.7%) cases and 14 (17.7%) controls (P=0.177), for a duration of 21 [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] days for cases and 15 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] days for controls (P=0.197).…”

COVID-19 update: Covid-19-associated coagulopathy

“…Hu et al determined the time to negative conversion of viral RNA in patients hospitalized with Covid-19 infection [15]. The median time from the first day of a positive RNA test to consecutive negative tests was 14 (IQR 10-18) days.…”

Prolonged nucleic acid conversion and false-negative RT-PCR results in Indonesian patients with COVID-19: A case series

“…For every 1 unit increase in Ct, the odds ratio for infectivity decreases by 32%. Some studies also reported that viral infectivity in patients with symptoms' duration > 8 days may be low [16,17]. Several factors might affect the occurrence of prolonged nucleic acid conversion, including older age, having comorbidities, such as diabetes and hypertension, and impaired immune function [18].…”